Provider Demographics
NPI:1417255514
Name:INFECTIOUS DISEASE ASSOCIATES OF SOUTHEASTERN KENTUCKY PSC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES OF SOUTHEASTERN KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEKOE
Authorized Official - Middle Name:BERNDT
Authorized Official - Last Name:OPOKU-OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-439-0800
Mailing Address - Street 1:PO BOX 1448
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1448
Mailing Address - Country:US
Mailing Address - Phone:606-439-0800
Mailing Address - Fax:606-439-6773
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9466
Practice Address - Country:US
Practice Address - Phone:606-439-0800
Practice Address - Fax:606-439-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40016174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty